Transcription - 20250806T 01-51.mp3

Next patient is fiona drey d r y e foxtrot 8502 I'll come back and see what you've done alright so you're using regular company yes go on investigations blood gas sub ph 7.436 sodium 134 glucose 6 ecg sinus rhythm at rate 72 ocrp 14 creatinine 43 at baseline inr 1.8 white cells 13.4 neutrophils 12.3 and what about the not that you don't feel well enough I don't know I mean you and you know doctor I'm 1 of the medical doctors any doctor who's speaking need to go into hospital which is why they've asked me to speak how are you feeling about 2 in the morning it's difficult to get sleep in here it looks the same number I heard that you fell off the toilet and hit your head I'm you oh my god that should mhmm make you feel a bit better I haven't told you where you are at the moment that's alright worry about some parents what does anyone told you I've put a physio in on a french ward in what sorry h ward yeah you have been in ward very recently but you're in a and e recess at the moment just in a and e because you came in today oh okay has anyone do need a month before you have the chance very often I think I've august very good that's fine great thank you so you had a scan of bailey's bleeding which is good that's right yeah it has shown some swelling which could be related to the previous operation that you had yeah or could be related to what's going on underneath that previous operation the glioblastoma good to say at this time is your neck tender I'll press on it is it sore no okay can you scan your neck and make sure you haven't heard it I'll ask them to do that that's what my no worries yeah I've seen you moving your arms can you move your legs side of my bed oh great no trouble there that's good get up and up and I'll have a quick listen to your chest do you mind normal good listen over here do some big breaths for me just nice and clear how are your bladder and bowels doing no pain passing through the toilet anything like that cough or cold no but the you think the reason that you fell off the toilet is because of what's happening in your head can mean you lose your balance a little bit and like I'm weak in different parts of you want to do maybe maybe after the operation as I say or maybe you have to explain underneath that we'll probably make a move I know that the appointment hospital been very brief I see from the past but you feel like you're getting you've been weaker the last day or so they they heal every week I see and that's okay those those set numbers yeah yeah reports be safe yeah and scan your neck yeah so the plan is we scan your neck I'll speak to the neurosurgeons about what's going on in your head and see if they've got any advice and put you on some steroids to dampen dampen down any swelling to make sure you don't have any seizures yeah and then to rest time keppra and then to rest time yeah fine brilliant blood pressure is right okay she's 70 so everything looks good on the monitor okay that's alright I'll get all these things sorted for you let you get some rest okay and then next time I'll work out until you get some rest

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Medical ST4 Miller Clerking

Presenting Complaint:
Fall with head injury following recent craniotomy

History of Presenting Complaint:
Patient presented to A&E following a fall from toilet with head injury. She reports feeling increasingly weak over the past day or two. The fall occurred in the context of recent neurosurgical intervention for intracranial tumour. Patient has a history of craniotomy performed on 30th June 2025 for right parietal tumour resection. The underlying diagnosis was initially uncertain between glioblastoma and lymphoma, diagnosed 23rd June 2025. Patient reports difficulty sleeping in hospital environment. She denies any neck pain on examination. No current urinary or bowel symptoms. No cough or cold symptoms reported.

Past Medical History:
• Elective right parietal craniotomy for tumour resection - Glioblastoma 30/06/2025
• Essential hypertension

Drug History:
• Levetiracetam 1g PO BD
• Dexamethasone 2mg PO OD
• Lansoprazole 30mg PO OD (whilst on dexamethasone)
• Levetiracetam 500mg PO BD
• Beconase Aqueous 50mcg BD (both nostrils)
• Amlodipine 5mg PO ON

Allergy History:
• NKDA

On Examination:
General Appearance: Alert, oriented but reporting weakness
Observations: HR 61 bpm, BP 118/68 mmHg, Temp 37.3°C, RR 15/min, O2 sats 98% on air, ACVPU: Alert
• Neurological: Able to move all limbs. No neck tenderness on palpation. Cranial nerves not formally assessed
• Cardiovascular: Regular rhythm, no murmurs audible
• Respiratory: Clear chest on auscultation bilaterally
• Skin: Normal perfusion
• Urological: Passed urine within 6 hours

Investigations:
• Blood gas: pH 7.436, sodium 134, glucose 6
• ECG: Sinus rhythm, rate 72 bpm
• CRP 14, Creatinine 43 (baseline), INR 1.8
• White cells 13.4, Neutrophils 12.3
• CT head without contrast (06/08/2025): Surgical cavity in right parietal lobe with severe surrounding vasogenic oedema, mass effect with midline shift and transtentorial herniation. No intracranial haemorrhage

Impression:
Progression of glioblastoma multiforme with significant cerebral oedema causing mass effect and herniation

Management Plan:
1. High dose dexamethasone 8mg IV for 48 hours with PPI cover
2. Continue Levetiracetam for seizure prophylaxis
3. CT cervical spine to exclude neck injury following fall
4. Neurosurgical review completed - confirmed GBM progression
5. Admit under oncology team for further management
6. Not suitable for further neurosurgical intervention
7. Oncology bed required
8. Escalation plan to be discussed with oncology team regarding ceiling of care

Summary

Investigations

Plans